Health System Strengthening

Health System Strengthening

This theme draws on sociology, anthropology, and innovative health systems research methods. It will assess the efficiency, equity and sustainability of current MDA approaches and support country partners to develop new or adapt existing interventions to strengthen NTD programme delivery. The overall aim of the social science research theme is to assess the efficiency, equity and sustainability of current Neglected Tropical Disease (NTD) control approaches, with a specific focus on end-user perspectives, to develop potential interventions to strengthen programmes at the national, district, community and household level.

Activities are situated around five core research themes that span all levels of the health system as detailed below. Cutting across all the research themes is a focus on mainstreaming gender and intersectional analysis in promoting the needs of the most vulnerable and marginalised.

1. Funding, governance, and donor priorities

Funding, governance, and donor priorities often dictate the way that health systems and disease programmes operate. Consideration of these factors is therefore critical in evaluating potential for scale up and sustainability of new and existing NTD control interventions. It is particularly important to understand how decisions made by policy makers, governments and donors can impact on the planning and delivery of services.

2. Partnership and multi-sectoral working beyond the health sector

It is thought that multi-sectoral responses are critical to the control and elimination of NTDs, for example encouraging the health sector to link with agriculture or zoonosis departments. However, little evidence presently exists about their feasibility and impact on systems and communities. Nor is there much evidence on different types of collaboration for example public-public partnerships (i.e. the Ministry of Health working with the Ministry of Education, Agriculture, Water Resources, Gender, Children and Social Protection); public-private partnerships (i.e. the Ministry of Health working with pharmaceutical companies; banks); public-non-profit partnerships (i.e. the Ministry of Health working with the voluntary sector; development agencies). Through this work we will identify opportunities and challenges for working beyond the health sector and explore community perceptions of these partnerships.

3. Health systems integration and disease programme co-implementation

While vertical health programmes have benefits in terms of achieving rapid success in relation to disease control, sustainability can be challenging and often they fail to strengthen the overall health system. Co-implementation is often the first step toward more integrated control of disease. This work will explore the advantages and disadvantages of co-implementation and integration of NTD control into health systems, identify how the health system is currently supporting the NTD control programme and vice versa, whilst exploring how health system resources could be better leveraged to deliver more effective and equitable scale-up of NTD activities. This will include a focus on community perceptions of the benefits and challenges and the impact on community drug distributors and other health volunteers.

4. Close-to-community providers/community drug distributors

Community health workers and community drug distributors are the lynch pin of mass drug administration activities for NTD control and elimination, however few studies look at their experiences of such programmes and how they are supported, motivated, and integrated into the wider health system. Community workers are often most impacted by decisions of co-implementation, integration, changes in funding, and multi-sectoral collaborations. We hope that exploring these issues from their perspective will allow for more informed and responsive policy and programming that is likely to retain a highly motivated and dedicated cadre of close-to-community providers working on NTD control.

5. Gender, Equity, Rights and NTDs

It is critical that NTD programming and its scale-up is equitable and informed by community voices so that no sections of the population are ‘left behind’ in striving toward control and elimination of NTDs. This research will explore how socio-economic factors such as poverty, age, gender, stigma and disability are accounted for within NTD programming and how they shape access to interventions. This will include an exploration of the knowledge, attitudes and beliefs of different community members, barriers to service access with a particular focus on those marginalised by existing NTD programmes (e.g. out of school children, pregnant women, people living with disability), exploration of the socio-economic characteristics of areas that have persistent transmission of specific NTDs, and better understanding of NTD-related stigma and its impact of service uptake and morbidity management and disability inclusion.